Answer to Medical Mystery Monday #19

A real human brain. The cerebellum, responsible for balance and coordination, is highlighted in pink. Image from mybrainnotes.com.

The answer to yesterday’s mystery is… paraneoplastic syndrome with cerebellar degeneration! Only one reader got it exactly right – O’B1. Very nice job.

Paraneoplastic syndromes are a group of diseases that occur in patients who have cancer, but they are not caused directly by the cancer or its treatment. For an unknown reason, patients with cancer sometimes make antibodies that attack their own brain. In this case, the patient’s antibodies were destroying the part of the brain called the cerebellum, which is responsible for balance and coordination of movement. This caused the patient’s wobbly walk, visual changes, and difficulty talking and swallowing. Typically, a few days before these overt motor symptoms occur, the patient experiences nausea and vomiting (the “stomach bug” in our patient). The slide of the brain cells depicts degeneration of an important cell layer (Purkinje cells) within the cerebellum.

Very unfortunately for our patient, both the lung cancer and the paraneoplastic syndrome with cerebellar degeneration are difficult to treat. Depending on the type of antibodies that are attacking the cerebellum, the doctor may prescribe a medication to suppress the immune system. The patient should also continue treatment with chemotherapy and radiation for his lung cancer.

Hope you enjoyed learning about this rare complication of cancer. Thanks again to the reader who suggested it. If you have a disease that would make a good medical mystery, you can email me at mdtobeblog@gmail.com.

You know what, Patti Ann, it very likely could have been! That absolutely would go on our differential diagnosis for this patient. My (weak) reason for that being wrong is because I can’t think of a chemo drug that treats small cell lung cancer that has a side effect of cerebellar toxicity. Please let me know if I’m wrong!

Patti Ann, I couldn’t agree with Marianne more. I’ve been trying to find a chemo. drug that is in use now or was used in the past for SCLC that would cause cerebellar toxicity. The best I can come up with is cisplatin and that link is virtually non-existant.

On a lighter note…I guess that I am the nerd that my friends have been accusing me of being. I thought that my use of “convoluted” in comment 1. was halarious….Ya’ know, cause were dealing with the brain.

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